Endometriosis

Endometriosis is related to retrograde menstruation or coelomic metaplasia and depends on the presence of estrogen. It is a consequence of menstruation into an area that has no outlet for menstrual blood. As a result, antigenic substances are released, causing an inflammatory response and the formation of prostaglandins. Subsequent inflammatory repair distorts pelvic anatomy and the prostaglandins affect ovarian, tubal and uterine function. Symptoms are not specific, so definitive diagnosis depends on laparoscopy or laparotomy for confirmation. Medical therapy is aimed at reducing the estrogen on which the endometriotic lesions depend. Danazol, a testosterone derivative, does this by interfering with ovarian follicular development, and often results in both symptomatic and objective improvement. When therapy is withdrawn, the renewed estrogen stimulus may cause the lesions to recur. Conservative surgical therapy (the excision of endometriotic nodules and the restoration of pelvic anatomy while leaving a reproductive potential) is equally successful. Radical surgery (abdominal hysterectomy and bilateral salpingo-oophorectomy) is definitive, removing both the stimulus for endometriotic growth and the source of renewal.